The paramedic service is stretched to the breaking point and increasingly, there are no ambulances available when a rural resident suffers a medical emergency, say officials representing those first responders.
“There’s 60 per cent more calls for 911 today than we were seeing about 10 years ago,” said Mike Parker, president of the Health Sciences Association of Alberta, the union representing paramedics.
“But now we’re down to zero available resources — zero paramedics in regions that are already not receiving an equal level of response.
“And when seconds matter, the ambulance isn’t 10 or 15 minutes away. It’s an hour away.”
That’s far more than elsewhere, said the president of the Alberta Paramedic Association.
“In rural EMS systems in other jurisdictions, 22 minutes would be the maximum people would have to wait for an ambulance, and even that seems like a long time,” said Dusty Myshrall. “In Alberta, we’re not even keeping up to those numbers for response times. We’re off the charts.
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“In a world where minutes make a difference in whether someone lives or dies, that’s going to have a substantial impact on the outcome of patients.”
That’s a result of an increase in calls, said an Alberta Health Services spokesperson.
“EMS continues to see an unprecedented increase in emergency calls due to several combined factors, including the COVID-19 pandemic, opioid concerns, and emergency calls related to people returning to regular levels of activity,” AHS said in a written statement.
“Despite this historic increase in demand, EMS continues to respond to the vast majority of serious 911 calls quickly and appropriately. We are ensuring that the most critical patients are prioritized for receiving immediate care.”
There are a number of other factors at play, Myshrall and Parker said.
One is the province’s centralized health-care system, which sends ambulances from smaller communities to urban centres if they are the closest available unit.
“The problem is that the closest available units aren’t close anymore,” said Parker, adding ambulances 50 or 100 kilometres away are often called to respond to an urban call.
Occasionally it’s even longer, Myshrall said in an interview late last month.
“Just yesterday, there was an ambulance travelling almost two hours across Alberta to get to a call in Calgary,” he said. “That means every community between there had no ambulance available. That’s just a sample of what happens here on a daily basis now.”
Code red
In the past, the health-care system “would do anything it could” to keep ambulances staffed and in service, he added.
“Now, it’s become acceptable that ambulances are just out of service,” said Myshrall. “The public doesn’t know about that. It’s not like a brick-and-mortar hospital where you can see the lights are on or off.
“You don’t know there aren’t any ambulances in your community until you dial 911 and are waiting 45 minutes for help.”
A decade ago, a ‘code red’ — when there are no available ambulances — would only happen “once in a blue moon” but it’s now a daily occurrence, said Parker.
“The system is designed for each area to have appropriate resources, but if the ambulance that’s assigned to that rural community is now moved down into a larger community, that leaves the entire area vulnerable,” said Parker.
“There’s no way that a Coaldale or a Canmore or a Westlock ambulance should be doing calls in Edmonton. The system isn’t designed for that. They belong in their community to be available for the people in need there.”
His union said this fall there were at least 135 code reds in a 50-day period from late August through mid-October. But it’s tricky to pinpoint just how often they are happening in rural communities. One town may be without an ambulance one day and another town a day later, but the cumulative effect is that resources are being drawn from rural Alberta to address ambulance shortages in urban centres.
“There’s a lot of media attention on the Edmonton and Calgary code reds, but we’re seeing those exact same situations happening every day in rural Alberta,” said Myshrall. “We see communities on a daily basis going without their ambulances.”
And while the pandemic has flipped Alberta’s entire healthcare system on its head, the current lack of resources is more systemic, he added.
“I think the pandemic has become an excuse for the failing EMS system,” said Myshrall.
“What the pandemic has done is just highlight the issues with the system as it was failing. We saw this trajectory years before we ever got to this point.”
Parker agrees.
“The government has said things like, ‘It’s really hot. It’s really smoky. There’s COVID. Opioid overdoses. Alberta being open again,’” he said. “Every time we raise the issue, it has a new justification for why it takes an hour for an ambulance to get to your call.
“But when you see we’ve added zero additional resources — and in some cases have removed resources — we come up with a system that just cannot keep up with the call volume.”
‘Clear and present’ risk
Another issue is that EMS services used to simply provide emergency response to 911 calls, but has become “an extension of health care,” said Myshrall.
“Because we’ve centralized our health-care model, a lot of patients coming into rural hospitals have to be transferred to the city by an ambulance,” he said. “They can’t just drive themselves to the city — they have to go by ambulance once they’re through the emergency department. That stretches our resources even thinner.”
Another problem is how shifts are set up. Although it can vary, paramedics are generally on call 24-hours a day for a four-day period, then off shift for four days.
That may have worked when call volumes were much lower, but now “these ambulances are going non-stop,” said Myshrall.
Once a crew is on task for 14 hours, it’s automatically taken out of service for an eight-hour rest period.
“When that ambulance comes out of service, it can’t respond to anything,” he said. “In fact, they won’t even know that a 911 call came in. Someone could be two houses down from where that ambulance is parked and that ambulance can’t respond to them because it’s out of service for eight hours.”
This “archaic staffing model” leads to burnout that puts both paramedics and the public at risk, said Myshrall.
In August, Alberta Health Services said it would provide $8.3 million to “stabilize staffing” at EMS because of high call volumes. But it only moved people from temporary positions to full-time ones.
“There’s not one additional paramedic getting into an ambulance today,” said Parker. “We’ve been talking about this for 10 years. Successive governments have not addressed this issue. Nobody has taken a serious look at what’s happening.”
And if more paramedics aren’t hired, the problem will worsen as ones on the job become burned out and leave, said Myshrall.
“And then just like in the city centres, people are going to have to wait for an hour for an ambulance to show up,” he said.
“The risk is clear and present,” added Parker. “It’s not even a risk for the future — it’s a reality of today. When you dial 911, the closest ambulance isn’t close.”
